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Demographics of patients suffering from snake bite, retrieved by the Royal Flying Doctor Service within Western Australia over a 10-year period: Learning from the Past


Russell Jones / Stephen Langford
Royal Flying Doctor Service


Prof. Russell Jones is the Professor of Clinical Education for the Royal Flying Doctor Service, Western Operations and for the School of Medical and Health Sciences at Edith Cowan University.  He is also the Director of the ECU Health Simulation Centre.  He was the inaugural Director of Education for the Australian and New Zealand College of Anaesthetists for seven years responsible for education and training activities within anaesthesia, intensive care and pain medicine, the inaugural Director of Assessment for the Royal Australian College of General Practitioners, and has established a College of Health Sciences in the Middle East.



Snake bites are life-threatening for Australians living and working in remote areas.  Each year the RFDS evacuates many cases at significant cost.  Telephone triage is difficult from a distance but genuine envenomation is life-threatening.  Little is known of the eventual RFDS patient outcomes and if the retrieval and management was appropriate.
This study investigates the outcomes of patients evacuated over 10 years, to determine the true incidence of snake bite and envenomation in RFDS practice.  
All patients transferred by the RFDS in WA over a 10-year interval from 2006 to 2015 were identified from our retrieval database.  Original documentation for every case, including preflight medical assessments and in-flight observations charts were reviewed and key data fields entered into a study database.  Requests were made to recover discharge summaries from destination hospitals for all patients transferred.  When available, these were matched to retrieval records and appended to the dataset.
Results of this study may be extrapolated to all aeromedical retrieval services within Australia, especially those serving the vast rural and remote regions.  
We identified 566 patients transferred with a diagnosis of snake bite or envenomation.  The demographics of patients referred for retrieval, including age, gender, ethnicity, and regional distribution are presented.  The characteristics of the snake bite; the circumstances in which it occurred and first aid measures are also summarized.  The distribution of transfer requests, retrieval distances and transfer times are presented as are transport decisions regarding priority, crew mix and in-flight management.  
Hospital discharge and outcome data are being collated and preliminary results suggest only a very small number of patients experience genuine envenoming. There is potential to both reduce unnecessary flights and to improve the triage and management of patients with a serious life-threatening condition.



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